I've got something on my mind that's been eating me for awhile.the fact that I just don't feel as though my skill level is sufficient to be safe and effective as a PT. I've talked to people i'm close to about it, and they just think it's stupid...they don't understand why I feel the way I do. I graduated last year and have been practicing ever since.

I was a terrible student in PT school; profs were not fond of me; and I failed three practical exams--I had actually maxed out on practical failures and was given a second chance because, in the words of the program director, "in my 25 years I had never encountered this problem before." It's not as if I didn't try...one semester I was having issues with an ex who had been stalking me and that was rough but the other semester it was like I was just struggling and I couldn't get it even when I tried.

Then I want on internships and everything was fine. Of course, our program pretty would basically just match you to what they think you can do. So if you're not strong in neuro, they won't let you do inpatient rehab. If you're not strong in manual therapy, for your ortho requirement they'll stick you at a facility that's protocol based where you won't do much manual. Everybody does acute care but we had a CI speak to our class and she mentioned that our director will "warn" sites about students who don't know their stuff or have strong personalities. So...even though I passed my clinicals without an issue, I can't say that it means much as far as whether or not I met the standards for the program. I keep thinking that with time I was going to feel better about my skill level. But I spent 7 months on internship, have been working for almost a year, and nothing's changed.

I don't know if I really ever got honest feedback about my overall skill level when I was on clinical. I wish there was something I could do, a concrete goal that I could set for myself to affirm my competency. I think if I were to do a residency and complete it successfully then it would change my outlook--but I just don't think that a residency is for me. Those types of programs attract the cream of the crop...and plus, I know that my motives may not be in line with theirs exactly.

I'm just very sad. After I finished my last practical, I told the professor how relieved I was to never have to take a practical again. And she said, yes you will, everyday when you walk into the clinic. There is truth to that--these are the skills you're supposed to know as a PT. But now when I go to work I feel just as insecure as I did two years ago when I had my practicals only the grades are never posted and I never know if I've passed. I know that at this point of the game, I should feel within myself that my skill level is good enough. But I don't...

Keep posting more specific case situations here for others to facilitate your ongoing learning. It is true that you are always taking a practical exam with each patient, but the grade comes based on how the patient does over a few weeks of time.

I am sure there are more that are willing to help you here, but if you could give us more specific information about what skills you feel you are lacking confidence in, then we cna better guide you.

Is it evaluation, special testing, ROM, muscle testing? Is it taking that information from examination and formulating a treatment plan? Is it exercise progression? Is it differential diagnosis issues to decide shoulder impingement vs RC tendinitis?

I would do a residency. There are a lot out there. Whether you go to a full-time, year-long residency or a hybrid program like EIM or Andrews/NAIOMT or the long-course through (I think), The Manual Therapy Institute, you will become more confident. I'm not sure about neurologic or geriatric residencies but you can check the APTA's website. Through residency, you will gain mentorship and exposure to everything you are not confident about. Best of luck!

For TLB: I am in outpatient ortho. There are no structured mentors so to speak...there are 8 PTs in the clinic and 3 of them have 5+ yrs on the job.

To GaryD:I can't think of anything specific that I know I need to work on...it's more general. And, realistically, I know that not all of my patients are going to get better. But when they don't get better, I don't know if it's because I didn't do a better job or they needed something above and beyond PT.

Not so sure this is such a major thing or uncommon. When I first graduated, I had done such awesome internships under amazing mentors that I falsely believed I was a great clinician. My confidence was unfounded. the more I began to learn the more I learned what I needed to learn. the more I knew the more I knew what I didn't know.

I think this is just a maturation process of being able to realize that you may not be the best you will be at this given moment in time, but how you handle this will define you. I shutter to think of some of the treatment protocols I used to employ when treating patients in my first 1-2 years. I have confidence in my abilities now because I have over 12 years of experience to stand on that helped me shape my techniques and approaches, but I am still learning, and will always be learning. After reading so much of the pain theorists on here, I had to do a long hard look in the mirror and at research, and could no longer be ignorant to the changing landscape of pain theories and therefore pain control theories.

I don't think there is anything wrong in your lack of confidence, I would caution you to not let it show to your patients, but do not be falsely arrogant. I would advise explaining everything out loud to your patients what you are doing, or get a student yourself you can explain things to. The more you say your Dx rationale and treatment rationale out loud the more you will refine it and understand it and hopefully believe it yourself. If you cannot explain it out loud, start doing some serious reading or find a mentor, even on line, linked in, here, somewhere local. Someone you can talk through a few cases and what you found and what you did. Remember there are 10000 ways to skin a cat (so I have heard?). That is, your exact treatment may not be the same as the guy next to you, but your core fundamentals should be similar in many instances. You may prefer to use a total gym while someone else a leg press machine, and both are concentric eccentric loading lower kinetic chain exercises and have their time and place just like a SAQ has its methods and time and place.

I think it is good you are not sure if it is your treatment, your dialogue and permission to the patient to get better, or mother nature etc. We can never be 100% sure of this. You are a movement scientist, not a magician. You have knowledge of human anatomy and physiology and pathology and bio mechanics, and the patient does not. Therefore, no matter what, to them, you are an expert in the field, so tell them what you know, do not be afraid to say I don't know, or i will research that, but do not lie.

I think bgal (sorry for the abbreviation) brings up a lot of good points. Another way you can approach it is to pick one thing ( body part, mobilization, exercise style etc.) and work hard at that one thing first. If you try to learn everything it can be overwhelming so start with one thing and get comfortable build your confidence with that and then move onto the next thing. Don't worry about not knowing all the answers, the more I learn it seems we don't really have the answers and those people that think they know everything are often times spreading just as much bad information as good info. These days I try to keep things general like this technique helps to calm your shoulder down, or these exercises will help to build your system back up. Remember your non-physical interactions with your patients are just as important as your physical interactions. If your patients think that you don't care or if you show them a lack of confidence in your treatments they are going to have negative expectations. If you show your patients that you care that they get better and show them that you are confident that what you are doing will help they will have more positive expectations and that will lead to a more positive outcomes. When I go through a particularly rough time i like to take take my schedule from the day and go back and look and how I helped the different patients. Remember you don't have to "fix" them to help them just a useful piece of information can be helpful. Finally outcome measures help, sometimes it can be difficult for the patients and the therapist to see the patients improvement. Going over outcome measures with patients can be a way for both of you to see their progress and both of you to build confidence.

For TLB: I am in outpatient ortho. There are no structured mentors so to speak...there are 8 PTs in the clinic and 3 of them have 5+ yrs on the job.

To GaryD:I can't think of anything specific that I know I need to work on...it's more general. And, realistically, I know that not all of my patients are going to get better. But when they don't get better, I don't know if it's because I didn't do a better job or they needed something above and beyond PT.

Do not worry about the idea that all your patients need to get better. Yes that is the goal and hope, but we all have those that we just cannot help...they need surgery, are not compliant, we do not have the specialization technique to assist, etc. It happens to all of us and will into the future.

I think there have been many good suggestions brought forth thus far. COntinue to post here and do not be afraid to presnet a case like situation so we can help you along. If you are here to learn, there are many here that would be more than happy and willing to share ideas and thoughts (suggestions) for evalutaion, treatment, further reading/CE type work.

You may not have mentors at work, but you have an entire online community of mentors available to you, it is up to you to use them for your benefit.

Welcome to the internet! The greatest source of information ever for all your confidence problems. Why don't you subscribe to one of the great PT blogs out there and learn how they approach their patients?

When I started PT over 10 years ago, I sucked. I was also working in a private practice without a mentor and seeing anything and everything. I joined PTupdate.com and John Duffy and his website guided me through the first few years of my career. I learned and got better every year. I screwed up a bunch, but I became more and more comfortable with practice. The rest is history and PT is now a very enriching and enjoyable career for me. Give it some time. Don't be afraid to ask questions. Get some counseling if you have too much anxiety.

Hey jojo, It seems you are more of scared due to lack of confidence. Confidence comes with times, as you said you need to set some concrete goal, there’s a way of doing it. Choose the person whom you think is the best in your field. Try to learn or adapt the practice he/she follows. You first need to specialize in one area, this will build your patients security and with time you’ll get on the track being expert.